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Providers, not insurers, are responsible for excess U.S. health care cost (2024)

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Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#31

Post by anon291 »

dgellow wrote: post #23
jasonlotito wrote: post #17

Earlier quoted context omitted.

> Yep, for-profit healthcare is a bad idea. It's the main reason our USA healthcare costs so much. And yet it still exists in the rest of the world. But people tend to think of it only as for rich people as opposed to covering things the rest of the world ignore. I'm not saying the US is perfect, but having lived under both kinds of healthcare, cost and quality are two reasons I'm in the US.

Because you wanted to pay more? Or are you saying it is cheaper in the US? If the latter, could you be more specific? I pay the maximum possible in Germany for my health insurance and from what I understand I still pay less for healthcare than I would in the US.

Are you paying for the same thing? I can see a doctor or specialist usually within a week. Less if it's urgent. I think wait times in these countries are never mentioned. Paying for a service tomorrow vs paying for one a few months from now are entirely different classes of goods.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#32

Post by Spooky23 »

znnajdla wrote: post #9
neilwilson wrote: post #5

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortag…

It’s neither a matter of profits nor costs. It’s a matter of incentives. The basic principle of capitalism can’t work if the buyer doesn’t have a choice, if the buyer is not the one who usually pays, and if the payer has a way of avoiding responsibility to pay. The privatized health insurance system is truly and completely fucked up.

The buyer and sellers are frequently wrong. The buyer isn’t the patient, it’s the employer. The insurer is either charging a premium for risk or servicing work for a self-pay employer.

The biggest buyer is the Federal government and by law they are required to get the best deal, the government also restricts the supply of providers. It’s not a capitalist system at all. It’s a weird hybrid command economy with a consolidating cartel of providers and administrators.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#33

Post by rickydroll »

colechristensen wrote: post #16
neilwilson wrote: post #5

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortag…

The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…

Before we go pushing money into private insurance, we need to define why. We need to understand why the public ones are inadequate and who/what drove those decisions.

A public health care system should be independent of politics. Unfortunately, as the latest administration has shown, even if you designed it to be independent, such as the CFPB, it doesn't matter with an autocrat in charge. On the other hand, private industry does not have all that good a reputation for not effing with your healthcare.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#35

Post by stymaar »

tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

> This guy is way out of his depth.

It's literally Noah Smith, what did you expect?

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#36

Post by ngriffiths »

> It’s not hard to understand why people hate health insurers. When you interact with the U.S. health care system, the providers — the hospital staff, the doctor, the nurses, the technicians — all just take care of you.

> Your interaction with the health insurer, on the other hand, feels like a struggle against an enemy who wants to destroy you.

Exactly, the big factor driving healthcare costs is that people like expensive providers. They like the fancy plan that covers their doctor, that doesn't limit them to a community hospital. Any choice that involves retaining even the slightest market leverage is a deal breaker for many people. I think all the clever stuff we do to optimize costs and increase transparency is worth doing and helpful, but like, it will still be expensive. We want that!

Meanwhile it is not really better to go to an expensive doctor, in terms of health outcomes. So the public health problem is to stop people (and employers) from voluntarily wasting their money on healthcare, so we can use it for better stuff.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#37

Post by FireBeyond »

jasonlotito wrote: post #17
jayturley wrote: post #4

Yep, for-profit healthcare is a bad idea. It's the main reason our USA healthcare costs so much.

> Yep, for-profit healthcare is a bad idea. It's the main reason our USA healthcare costs so much. And yet it still exists in the rest of the world. But people tend to think of it only as for rich people as opposed to covering things the rest of the world ignore. I'm not saying the US is perfect, but having lived under both kinds of healthcare, cost and quality are two reasons I'm in the US.

I've lived for many years each in the UK, Australia and the US. I've worked as a healthcare provider for many years in the US.

I would dearly love to know what "costs" of healthcare you are looking at when you say the US is preferable enough to actually move to/be in/stay in the US.

Because when I can have higher end insurance from my employer, and still be out $9K for a kidney stone after insurance, I'm not seeing it. That is an outlier, for me, I'll acknowledge, but it's still nearly five digits that had to come out of my pocket after my employer paid thousands, I paid premiums, for insurance (that is insurance-in-name-only).

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#38

Post by dgellow »

anon291 wrote: post #31
dgellow wrote: post #23

Earlier quoted context omitted.

Because you wanted to pay more? Or are you saying it is cheaper in the US? If the latter, could you be more specific? I pay the maximum possible in Germany for my health insurance and from what I understand I still pay less for healthcare than I would in the US.

Are you paying for the same thing? I can see a doctor or specialist usually within a week. Less if it's urgent. I think wait times in these countries are never mentioned. Paying for a service tomorrow vs paying for one a few months from now are entirely different classes of goods.

Depends on the urgency and the specialist, but generally yes, I can get an appointment in a week. Mental health is the only specialty where I’ve seen multiple months wait times. For a specialist you generally first go through a generalist who gives you a voucher for your insurance. But you can also go directly and pay yourself if you want to skip that step.

Even if you have slightly more wait time, the cost is still way lower. Unless you have a US employer that pays the whole insurance for you (I don’t know if that’s possible)

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#39

Post by collingreen »

tdb7893 wrote: post #21

When arguing that health insurance isn't that inneficient he talks about "But when we look at United Health Group’s operating costs in the diagram above, they’re only 22.6% of the actual cost of medical care.". 22.6% for a middleman is not insignificant! Also providers have to spend a lot dealing with insurance so it's certainly an undercount of their total cost. This makes the burden of insurance seem like a huge %…

Well said. If this is the steel man then it's worse than I thought.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#40

Post by EvanAnderson »

anon291 wrote: post #29
eli_gottlieb wrote: post #25

Earlier quoted context omitted.

> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?

Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.

This can't be stated enough. I should have my comment w/ citations on standby, but I don't.

The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified.

The AMA is backpedaling on that stance now but the damage is already done.

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